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A Physician-Researcher Thrives in the Balance

On a typical Thursday recently, Regan Theiler saw 19 patients at a private clinic in the morning, then spent the afternoon growing placental tissue in her lab. That weekend, she could look forward to being on call, delivering babies late into the night. Monday, she would be in the lab again.

"This career path is not for someone who wants to have a big, happy family and go on three vacations a year with them and eat dinner with them every night. It's just not going to happen. [But] I wouldn't trade it for anything." --Regan Theiler

Her career is a fast-paced balancing act between science and medicine. But Theiler, 35, an assistant professor of obstetrics and gynecology at the University of Texas Medical Branch (UTMB) in Galveston, thrives on this contrast between the delivery room and the laboratory. Both feed her "high-stakes, high-intensity personality type," she says, but in different ways: one is physical and calls for quick decision-making; the other is intellectual and requires a long vision.

Establishing this balance has demanded Theiler's unwavering dedication, often in the face of both professional and personal obstacles. But it seems to be working. Not only is she an accomplished researcher, but "she is a very talented clinician as well," says Denise Jamieson, an ob-gyn and epidemiologist at Emory University and the Centers for Disease Control and Prevention, both in Atlanta. "It is a very unusual combination."

A scientist goes to medical school

Theiler went to college at DePaul University in Chicago, Illinois, and planned to become a doctor, but a summer internship made her passionate about scientific research. She considered continuing on to a Ph.D. program when she graduated in 1996, but she noticed that the doctoral students she knew were struggling to find jobs. The prospect "that you could have a doctorate and postdoctoral experience and still have no job security and be dependent on begging the government for money was really unattractive to me," she says.

Fortunately, "I didn't have to choose," she says. She decided to pursue both an M.D. and a Ph.D. at the University of Wisconsin School of Medicine and Public Health, knowing that she could always practice medicine if a research career didn't work out. "The medicine was almost a security blanket to make me marketable when I came out," she says.

As with most M.D.-Ph.D. programs, hers required her to start with 2 years of medical school coursework, then do her Ph.D. (which took her 3 years), and then return to medical school for clinical rotations. "Medical school was difficult in ways I didn't anticipate it would be," Theiler says. She had always been unconventional--"I'm gay and I'm very liberal and I'm very pro-choice," she says--and she found the medical school environment to be stiflingly conservative. She got a clear message: Get in line. "I really resented that in the beginning," she says.

Scientists seemed to be more tolerant of her punky, alternative style than doctors were. "Scientists are sort of embraced for being weird and creative," she says. What's more, she had developed a deep attachment to laboratory work, and she missed it when she was away studying medicine. In the beginning, a student job in a laboratory gave her a scientific "home," but lab work was impossible during her rotations. Without the balance, she was miserable.

Finding her niche

(Courtesy, Regan Theiler)

Regan Theiler's liberal attitude and punky wardrobe were considered unconventional among medical school students.

She came to love the medical work when she homed in on her specialty, obstetrics and gynecology, in her 3rd year of medical school. She had assumed it would be "touchy-feely" but she found that it was tough and fast-paced, like her. Unlike in internal medicine, if there's a problem, "I can almost always fix it, and I can often fix it today," she says. "That's very gratifying."

What's more, as an ob-gyn, she could follow her liberal, pro-choice principles even as she adopted the more conservative image of a doctor. "Of course, I can't show up in cutoff jeans and piercings and combat boots and a shaven head and be expected to be allowed to just do surgery on someone who doesn't know me," she says. "That's reasonable."

She was also attracted by the major scientific questions that are still outstanding in women's reproductive health. "We have very little idea what causes basic phenomena," she says. She hoped that she could fill a relatively unoccupied niche: obstetric virology. She had just finished her dissertation on a common obstetrics-related virus called cytomegalovirus (CMV), which can cause miscarriage, birth defects, and other problems if the mother is infected during pregnancy. "It was sort of fortuitous ... because I had no idea that I was going to go into ob-gyn."

During her residency at Emory University, which she began in 2003, Theiler knew that bench research was out of the question, because being on call would prevent her from going to the lab at the necessary intervals. "So I decided to use that time as sort of a postdoctoral experience in clinical research," she says. She approached Jamieson to serve as her faculty mentor for a clinical research project about CMV.

Jamieson tried to discourage Theiler at first. "I thought [her proposed project] was far too ambitious" for someone doing a residency, Jamieson says. Residents are expected to do 80 hours of clinical work each week, which leaves little time to sleep, much less to conduct research. And ob-gyn is a particularly demanding specialty because doctors can be called on to deliver babies at all hours. But Jamieson soon found out that Theiler "doesn't allow external barriers to get in the way," Jamieson says. "She proved me wrong."

Newborns are not routinely tested for CMV infection, but 1 in 750 children is born with or develops permanent disabilities such as vision loss and mental disabilities due to congenital CMV, according to the Centers for Disease Control and Prevention. Theiler wanted to know whether newborns could be noninvasively screened using their umbilical cord blood. For her research project, Theiler would go to the hospital, make a list of newborns, and send nurses to collect stored cord-blood samples for those babies. In her lab, Theiler found that by testing these cord-blood samples, she could detect undiagnosed CMV infections. In many cases, "the docs in the nursery never thought of CMV" as the cause of their young patients' symptoms, she says. Because treating these infections could help, Theiler now advocates the routine screening of all newborns for CMV, although "that's still controversial," she says.

Walking the line

When she finished her residency in 2007, Theiler discovered that all of that balancing had left her feeling unbalanced. "I was exhausted and really burned out and ... flat broke." Although she loved science, she wondered if it wouldn't be better to abandon research and go into private practice, through which she could make a lot of money and live more comfortably.

Fortunately, she found an opportunity at UTMB that gives her the flexibility and support that she dreamed of. UTMB has a unique combination of world-famous virology and obstetrics programs. It also participates in the Women's Reproductive Health Research (WRHR) Career Development Program, through which the National Institutes of Health supports early-career physician-scientists for up to 5 years. As a WRHR Scholar, Theiler has been able to establish her laboratory and research program while practicing medicine in UTMB's clinics and at Planned Parenthood.

Theiler describes her research not as "translational" but as "dissectional." That is, instead of taking laboratory findings to clinical settings, she goes the other direction, taking placental and embryonic tissues from her practice to her lab to do basic research on how they work. Currently, she's using the tissue to study the role of a molecule that she suspects may be involved in the establishment of pregnancy and the initiation of labor. In another line of research, she is infecting placental tissue with lymphocytic choriomeningitis virus, which, like CMV, can cause birth defects in a fetus. The purpose is to better understand the placenta's immune response. Once researchers have that basic understanding, she says, it will be possible to start real translational research that will lead to better treatments.

Theiler is now in her 3rd year of the WRHR program, and the next step for her is to secure a major research grant. Many clinician-researchers feel pressure to spend more time in the clinic because seeing patients makes money for the university. "I can make $1000 for the department in 45 minutes doing a C-section; I can cost the department thousands of dollars in 1 day doing a big experiment," she says. Fortunately, Theiler says, UTMB supports her research as well as her clinical work. "I'm lucky," she says.

Although Theiler's dual career works very well for her, she admits that it has come with sacrifices. One long-term relationship ended in part because Theiler's long hours and frequent moves were hard on her partner. "This career path is not for someone who wants to have a big, happy family and go on three vacations a year with them and eat dinner with them every night. It's just not going to happen," she says. But "I wouldn't trade it for anything."